Healthcare Provider Details

I. General information

NPI: 1144091687
Provider Name (Legal Business Name): INTEGRATED THERAPY NW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 N COUNTRY HOMES BLVD STE 101
SPOKANE WA
99208-4373
US

IV. Provider business mailing address

2007 E LEONA DR
SPOKANE WA
99208-8574
US

V. Phone/Fax

Practice location:
  • Phone: 509-821-0947
  • Fax:
Mailing address:
  • Phone: 509-821-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAISY MARIE SWANSON
Title or Position: OWNER
Credential: LMFT
Phone: 509-821-0947